AMERICAN JOURNAL OF PUBLIC HEALTH
EDITOR’S CHOICE Oral Health Across the Life Course My interest in public health dentistry began early. With a dentist for a father and a teacher for a mother, the importance of oral hygiene, preventive health care, and education were stressed throughout my upbringing. I didn’t realize until I began practicing dentistry myself that it wasn’t this way for everyone. While providing dental care in a private office that accepted state-funded children’s dental insurance, I treated many children with extensive decay, including a 9 year-old who needed 3 adult molars extracted—teeth that had erupted only 3 years earlier. In several cases, a referral to a pediatric dentist was indicated, yet most of the time, there was no participating provider nearby. Having insurance does not mean having access to care. When parents brought their children to me for emergency treatment, I would stress the importance of routine visits and prevention, only to lose the children to further care. The barriers faced by families were prohibitive: lack of transportation, inflexible work hours, inaccessible provider locations, and especially inadequate financial resources. These experiences motivated me to earn an MPH and focus my career on improving oral health for entire populations through improved policies and practices. The Affordable Care Act (ACA) stipulates that dental benefits be offered for children until age 19 years via state-based and federally funded marketplaces through stand-alone dental plans or medical plans that include dental coverage. Although pediatric dental insurance must be offered through these exchanges, only a few states mandate their purchase. Although pediatric dental care is viewed as 1 of the 10 essential health benefits, failure to mandate these plans reveals a disconnect between the perceived importance of dental versus medical coverage. Further, while pediatric dental insurance must also be offered through public insurance programs such as Medicaid and Children’s Health Insurance Program, states can choose which dental benefits to offer to adults under Medicaid. These benefits range from minimal to extensive dental coverage, as states do not have a minimum requirement for adult dental coverage under Medicaid. Since 2010, according to researchers at the American Dental Association, there has been an upward trend in young adults aged 19---26 years obtaining dental insurance, in contrast to the
downward trend that was documented from 2000 to 2010. This is likely due to a “spillover effect” for insurance plans that have voluntarily expanded their coverage to match medical coverage stipulations of parents covering their children until age 26 years. Thus, while the ACA has improved the opportunities of children and young adults to obtain dental insurance coverage, this is not true across the life course. As argued by Fox et al. in this issue (pp. e7-e10), if states fail to expand their Medicaid eligibility and benefits, many vulnerable adults may not be able to access needed care. Still, both access to and demand for dental care are expected to meaningfully increase as millions of people are newly insured. Policies and practices must be designed and implemented to address the needs of vulnerable populations. For instance, New York has joined other states in adopting a law, effective January 2015, that will allow dental hygienists working at an Article 28 facility (including hospitals, nursing homes, and acute care clinics) to form a collaborative practice agreement with a dentist who has a formal relationship with that same facility. This law enables dental hygienists to provide much needed preventive care without the physical presence of a dentist on site. It has been 15 years since the release of the US Surgeon General’s Report titled, Oral Health in America, which brought national attention to the “silent epidemic” of oral diseases that unequally burden poor children and adults. I remain hopeful that new policies and practices motivated by the ACA and other laws, including the mandatory offering of children’s dental insurance through state- and federal-based exchanges and expanded Medicaid coverage in many states, will lift certain barriers for families that I first witnessed as a young, practicing dentist. And yet, as a society we still have a long way to go to ensure oral health for everyone across the life course. j
January 2015, Vol 105, No. 1 | American Journal of Public Health
Ariel Port Greenblatt, DMD, MPH Assistant Editor, AJPH doi:10.2105/AJPH.2014.302477
EDITOR-IN-CHIEF ASSISTANT EDITOR DEPUTY EDITOR FEATURE EDITOR IMAGE EDITOR ASSOCIATE EDITORS
Mary E. Northridge, PhD, MPH Ariel P. Greenblatt, DMD, MPH Farzana Kapadia, PhD Gabriel N. Stover, MPA Aleisha Kropf Hortensia Amaro, PhD Eric R. Buhi, PhD Paul C. Erwin, MD, DrPH Michael R. Greenberg, PhD Sofia Gruskin, JD, MIA Said Ibrahim, MD, MPH Robert J. Kim-Farley, MD, MPH Stewart J. Landers, JD, MCP Stella M. Yu, ScD, MPH ASSOCIATE EDITOR FOR STATISTICS AND EVALUATION Roger Vaughan, DrPH, MS INTERNATIONAL ASSOCIATE EDITORS Kenneth Rochel de Camargo Jr, MD, PhD (Rio de Janeiro, Brazil) Daniel Tarantola, MD (Ferney-Voltaire, France) DEPARTMENT EDITORS Roy Grant, MA Government, Law, and Public Health Practice Public Health Policy Briefs Elizabeth Fee, PhD, and Theodore M. Brown, PhD Images of Health Public Health Then and Now Voices From the Past Mark A. Rothstein, JD Public Health Ethics Kenneth R. McLeroy, PhD, and Deborah Holtzman, PhD, MSW Framing Health Matters EDITORIAL BOARD Jeffrey R. Wilson, PhD, MS (2015), Chair Chinua Akukwe, MD, MPH (2015) Jermane Bond, PHD (2017) Gwen Chodur (2015) Keith Elder, PhD, MPH (2016) Thomas Greenfield, PhD (2015) Dio Kavalieratos, PhD (2016) Denys T. Lau, PhD (2017) Maureen Lichtveld, MD, MPH (2015) Justin B. Moore, PhD (2016) Samuel L. Posner, PhD (2015) F. Douglas Scutchfield, MD (2017) Ruth Zambrana, PhD (2016) STAFF Georges C. Benjamin, MD Executive Director/Publisher Ashell Alston, Interim Publications Director Brian Selzer, Interim Deputy Publications Director Morgan Richardson, Production Coordinator Michael Henry, Associate Production Editor (Sr) Aisha Jamil, Associate Production Editor (Jr) Mazin Abdelgader, Graphic Designer Vivian Tinsley, Subscriptions Manager FREELANCE STAFF Kelly Burch, Greg Edmondson, John Lane, Gary Norton, Michelle Quirk, Alisa Riccardi, Trish Weisman, Eileen Wolfberg, Copyeditors Nestor Ashbery, Sarah Cook, Marci McGrath, Chris Smith, Proofreaders Vanessa Sifford, Graphic Designer
Editor's Choice | 5
EDITOR’S CHOICE Oral Health Across the Life Course My interest in public health dentistry began early. With a dentist for a father and a teacher for a mother, the importance of oral hygiene, preventive health care, and education were stressed throughout my upbringing. I didn’t realize until I began practicing dentistry myself that it wasn’t this way for everyone. While providing dental care in a private office that accepted state-funded children’s dental insurance, I treated many children with extensive decay, including a 9 year-old who needed 3 adult molars extracted—teeth that had erupted only 3 years earlier. In several cases, a referral to a pediatric dentist was indicated, yet most of the time, there was no participating provider nearby. Having insurance does not mean having access to care. When parents brought their children to me for emergency treatment, I would stress the importance of routine visits and prevention, only to lose the children to further care. The barriers faced by families were prohibitive: lack of transportation, inflexible work hours, inaccessible provider locations, and especially inadequate financial resources. These experiences motivated me to earn an MPH and focus my career on improving oral health for entire populations through improved policies and practices. The Affordable Care Act (ACA) stipulates that dental benefits be offered for children until age 19 years via state-based and federally funded marketplaces through stand-alone dental plans or medical plans that include dental coverage. Although pediatric dental insurance must be offered through these exchanges, only a few states mandate their purchase. Although pediatric dental care is viewed as 1 of the 10 essential health benefits, failure to mandate these plans reveals a disconnect between the perceived importance of dental versus medical coverage. Further, while pediatric dental insurance must also be offered through public insurance programs such as Medicaid and Children’s Health Insurance Program, states can choose which dental benefits to offer to adults under Medicaid. These benefits range from minimal to extensive dental coverage, as states do not have a minimum requirement for adult dental coverage under Medicaid. Since 2010, according to researchers at the American Dental Association, there has been an upward trend in young adults aged 19---26 years obtaining dental insurance, in contrast to the
downward trend that was documented from 2000 to 2010. This is likely due to a “spillover effect” for insurance plans that have voluntarily expanded their coverage to match medical coverage stipulations of parents covering their children until age 26 years. Thus, while the ACA has improved the opportunities of children and young adults to obtain dental insurance coverage, this is not true across the life course. As argued by Fox et al. in this issue (pp. e7-e10), if states fail to expand their Medicaid eligibility and benefits, many vulnerable adults may not be able to access needed care. Still, both access to and demand for dental care are expected to meaningfully increase as millions of people are newly insured. Policies and practices must be designed and implemented to address the needs of vulnerable populations. For instance, New York has joined other states in adopting a law, effective January 2015, that will allow dental hygienists working at an Article 28 facility (including hospitals, nursing homes, and acute care clinics) to form a collaborative practice agreement with a dentist who has a formal relationship with that same facility. This law enables dental hygienists to provide much needed preventive care without the physical presence of a dentist on site. It has been 15 years since the release of the US Surgeon General’s Report titled, Oral Health in America, which brought national attention to the “silent epidemic” of oral diseases that unequally burden poor children and adults. I remain hopeful that new policies and practices motivated by the ACA and other laws, including the mandatory offering of children’s dental insurance through state- and federal-based exchanges and expanded Medicaid coverage in many states, will lift certain barriers for families that I first witnessed as a young, practicing dentist. And yet, as a society we still have a long way to go to ensure oral health for everyone across the life course. j
January 2015, Vol 105, No. 1 | American Journal of Public Health
Ariel Port Greenblatt, DMD, MPH Assistant Editor, AJPH doi:10.2105/AJPH.2014.302477
EDITOR-IN-CHIEF ASSISTANT EDITOR DEPUTY EDITOR FEATURE EDITOR IMAGE EDITOR ASSOCIATE EDITORS
Mary E. Northridge, PhD, MPH Ariel P. Greenblatt, DMD, MPH Farzana Kapadia, PhD Gabriel N. Stover, MPA Aleisha Kropf Hortensia Amaro, PhD Eric R. Buhi, PhD Paul C. Erwin, MD, DrPH Michael R. Greenberg, PhD Sofia Gruskin, JD, MIA Said Ibrahim, MD, MPH Robert J. Kim-Farley, MD, MPH Stewart J. Landers, JD, MCP Stella M. Yu, ScD, MPH ASSOCIATE EDITOR FOR STATISTICS AND EVALUATION Roger Vaughan, DrPH, MS INTERNATIONAL ASSOCIATE EDITORS Kenneth Rochel de Camargo Jr, MD, PhD (Rio de Janeiro, Brazil) Daniel Tarantola, MD (Ferney-Voltaire, France) DEPARTMENT EDITORS Roy Grant, MA Government, Law, and Public Health Practice Public Health Policy Briefs Elizabeth Fee, PhD, and Theodore M. Brown, PhD Images of Health Public Health Then and Now Voices From the Past Mark A. Rothstein, JD Public Health Ethics Kenneth R. McLeroy, PhD, and Deborah Holtzman, PhD, MSW Framing Health Matters EDITORIAL BOARD Jeffrey R. Wilson, PhD, MS (2015), Chair Chinua Akukwe, MD, MPH (2015) Jermane Bond, PHD (2017) Gwen Chodur (2015) Keith Elder, PhD, MPH (2016) Thomas Greenfield, PhD (2015) Dio Kavalieratos, PhD (2016) Denys T. Lau, PhD (2017) Maureen Lichtveld, MD, MPH (2015) Justin B. Moore, PhD (2016) Samuel L. Posner, PhD (2015) F. Douglas Scutchfield, MD (2017) Ruth Zambrana, PhD (2016) STAFF Georges C. Benjamin, MD Executive Director/Publisher Ashell Alston, Interim Publications Director Brian Selzer, Interim Deputy Publications Director Morgan Richardson, Production Coordinator Michael Henry, Associate Production Editor (Sr) Aisha Jamil, Associate Production Editor (Jr) Mazin Abdelgader, Graphic Designer Vivian Tinsley, Subscriptions Manager FREELANCE STAFF Kelly Burch, Greg Edmondson, John Lane, Gary Norton, Michelle Quirk, Alisa Riccardi, Trish Weisman, Eileen Wolfberg, Copyeditors Nestor Ashbery, Sarah Cook, Marci McGrath, Chris Smith, Proofreaders Vanessa Sifford, Graphic Designer
Editor's Choice | 5
